Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

The effects of dutasteride, tamsulosin, and the combination on storage and voiding in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the Combination of Avodart and Tamsulosin study

Prostate Cancer and Prostatic Diseases volume 12, pages 369–374 (2009)Cite this article

Abstract

This article reports the results of a post hoc analysis of the multicenter, randomized, double-blind Combination of Avodart and Tamsulosin (CombAT) study, which aimed to investigate the effects of dutasteride (0.5 mg), tamsulosin (0.4 mg), and their combination on storage and voiding symptoms in 4844 men aged ⩾50 years with moderate-to-severe lower urinary tract symptoms (International Prostate Symptom Score ⩾12), prostate volume (PV) ⩾30 cm3 and PSA 1.5–10 ng ml−1. After 24 months, combination treatment achieved significantly greater mean reductions in both voiding and storage symptoms than either monotherapy, in each of the three baseline PV tertiles (30 to <42, 42 to <58, ⩾58 cm3). Dutasteride was as effective as tamsulosin for control of storage symptoms, but provided significantly greater relief of voiding symptoms than tamsulosin.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 2003; 61: 37–49.

    Article  PubMed  Google Scholar 

  2. Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006; 50: 1306–1314; discussion 1314–1315.

    Article  PubMed  Google Scholar 

  3. Roehrborn CG . Combination medical therapy for lower urinary tract symptoms and benign prostatic hyperplasia. Rev Urol 2005; 7 (Suppl 8): S43–S51.

    PubMed  PubMed Central  Google Scholar 

  4. Rosenberg MT, Staskin DR, Kaplan SA, MacDiarmid SA, Newman DK, Ohl DA . A practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care setting. Int J Clin Pract 2007; 61: 1535–1546.

    Article  CAS  PubMed  Google Scholar 

  5. Abrams P, Andersson KE . Muscarinic receptor antagonists for overactive bladder. BJU Int 2007; 100: 987–1006.

    Article  CAS  PubMed  Google Scholar 

  6. Garg G, Singh D, Saraf S . Management of benign prostate hyperplasia: an overview of alpha-adrenergic antagonist. Biol Pharm Bull 2006; 29: 1554–1558.

    Article  CAS  PubMed  Google Scholar 

  7. Nitti VW . Is there a role for alpha-blockers for the treatment of voiding dysfunction unrelated to benign prostatic hyperplasia? Rev Urol 2005; 7 (Suppl 4): S49–S55.

    PubMed  PubMed Central  Google Scholar 

  8. Rossi C, Kortmann BB, Sonke GS, Floratos DL, Kiemeney LA, Wijkstra H et al. Alpha-blockade improves symptoms suggestive of bladder outlet obstruction but fails to relieve it. J Urol 2001; 165: 38–41.

    Article  CAS  PubMed  Google Scholar 

  9. Malloy BJ, Price DT, Price RR, Bienstock AM, Dole MK, Funk BL et al. Alpha1-adrenergic receptor subtypes in human detrusor. J Urol 1998; 160 (Pt 1): 937–943.

    CAS  PubMed  Google Scholar 

  10. Emberton M, Zinner N, Michel MC, Gittelman M, Chung MK, Madersbacher S . Managing the progression of lower urinary tract symptoms/benign prostatic hyperplasia: therapeutic options for the man at risk. BJU Int 2007; 100: 249–253.

    Article  CAS  PubMed  Google Scholar 

  11. Issa MM, Kraft KH . 5alpha-reductase inhibition for men with enlarged prostate. J Am Acad Nurse Pract 2007; 19: 398–407.

    Article  PubMed  Google Scholar 

  12. Roehrborn CG, Boyle P, Nickel JC, Hoefner K, Andriole G . Efficacy and safety of a dual inhibitor of 5-alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology 2002; 60: 434–441.

    Article  PubMed  Google Scholar 

  13. Kirby R, Lepor H In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (eds). Campbell-Walsh Urology, 9th edn. 2007, Saunders Elsevier: Philadelphia.

  14. Roehrborn CG, Siami P, Barkin J, Damiao R, Major-Walker K, Morrill B et al. The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. J Urol 2008; 179: 616–621.

    Article  CAS  PubMed  Google Scholar 

  15. McConnell JD, Roehrborn CG, Bautista OM, Andriole Jr GL, Dixon CM, Kusek JW et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003; 349: 2387–2398.

    Article  CAS  PubMed  Google Scholar 

  16. Siami P, Roehrborn CG, Barkin J, Damiao R, Wyczolkowski M, Duggan A et al. Combination therapy with dutasteride and tamsulosin in men with moderate-to-severe benign prostatic hyperplasia and prostate enlargement: the CombAT (Combination of Avodart and Tamsulosin) trial rationale and study design. Contemp Clin Trials 2007; 28: 770–779.

    Article  CAS  PubMed  Google Scholar 

  17. Roehrborn CG, Siami P, Barkin J, Damiao R, Becher E, Minana B et al. The influence of baseline parameters on changes in IPSS with dutasteride, tamsulosin and combination therapy among men with symptomatic BPH and an enlarged prostate (⩾30 cc): two-year data from the Combination of Avodart and Tamsulosin (CombAT) study. Eur Urol 2009; 55: 461–471.

    Article  CAS  PubMed  Google Scholar 

  18. Hakkinen JT, Hakama M, Huhtala H, Shiri R, Auvinen A, Tammela TL et al. Impact of LUTS using bother index in DAN-PSS-1 questionnaire. Eur Urol 2007; 51: 473–477; discussion 477–478.

    Article  PubMed  Google Scholar 

  19. Chatelain C, Denis L, Foo KT, Khoury S, McConnell J, Abrams P et al. Recommendations of the International Scientific Committee: evaluation and treatment of lower urinary tract symptoms (LUTS) in older men. In: Chatelain C, Denis L, Foo KT, Khoury S, McConnell J (eds). Proceedings of the Fifth International Consultation on Benign Prostatic Hyperplasia. Health Publications Ltd: United Kingdom, 2001, pp 519–534.

  20. Barry MJ, Williford WO, Fowler Jr FJ, Jones KM, Lepor H . Filling and voiding symptoms in the American Urological Association symptom index: the value of their distinction in a Veterans Affairs randomized trial of medical therapy in men with a clinical diagnosis of benign prostatic hyperplasia. J Urol 2000; 164: 1559–1564.

    Article  CAS  PubMed  Google Scholar 

  21. Roehrborn CG, McConnell JD, Saltzman B, Bergner D, Gray T, Narayan P et al. Storage (irritative) and voiding (obstructive) symptoms as predictors of benign prostatic hyperplasia progression and related outcomes. Eur Urol 2002; 42: 1–6.

    Article  PubMed  Google Scholar 

  22. Mirone V, Imbimbo C, Longo N, Fusco F . The detrusor muscle: an innocent victim of bladder outlet obstruction. Eur Urol 2007; 51: 57–66.

    Article  PubMed  Google Scholar 

  23. Kaplan SA, Roehrborn CG, McConnell JD, Meehan AG, Surynawanshi S, Lee JY et al. Long-term treatment with finasteride results in a clinically significant reduction in total prostate volume compared to placebo over the full range of baseline prostate sizes in men enrolled in the MTOPS trial. J Urol 2008; 180: 1030–1032; discussion 1032–1033.

    Article  CAS  PubMed  Google Scholar 

  24. de Groat WC, Yoshiyama M, Ramage AG, Yamamoto T, Somogyi GT . Modulation of voiding and storage reflexes by activation of alpha1-adrenoceptors. Eur Urol 1999; 36 (Suppl 1): 68–73.

    Article  CAS  PubMed  Google Scholar 

  25. Kirby R, Andersson KE, Lepor H, Steers WD . Alpha(1)-Adrenoceptor selectivity and the treatment of benign prostatic hyperplasia and lower urinary tract symptoms. Prostate Cancer Prostatic Dis 2000; 3: 76–83.

    Article  CAS  PubMed  Google Scholar 

  26. Hyman MJ, Groutz A, Blaivas JG . Detrusor instability in men: correlation of lower urinary tract symptoms with urodynamic findings. J Urol 2001; 166: 550–552; discussion 553.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was funded by GlaxoSmithKline. Medical writing assistance in the preparation of this paper was provided by K Carpenter and funded by GlaxoSmithKline.

Author information

Authors and Affiliations

  1. Division of Urology, University of Buenos Aires, Buenos Aires, Argentina

    E Becher

  2. Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA

    C G Roehrborn

  3. Welborn Clinic, Evansville, IN, USA

    P Siami

  4. Clinical Development, GlaxoSmithKline, Research Triangle Park, NC, USA

    R P Gagnier

  5. Biostatistics and Programming, GlaxoSmithKline, Research Triangle Park, NC, USA

    T H Wilson

  6. Department of Urology, Università Vita-Salute San Raffaele, Milan, Italy

    F Montorsi

Authors
  1. E Becher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C G Roehrborn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P Siami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R P Gagnier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T H Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F Montorsi
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the CombAT Study Group

Corresponding author

Correspondence to E Becher.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Becher, E., Roehrborn, C., Siami, P. et al. The effects of dutasteride, tamsulosin, and the combination on storage and voiding in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the Combination of Avodart and Tamsulosin study. Prostate Cancer Prostatic Dis 12, 369–374 (2009). https://doi.org/10.1038/pcan.2009.37

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/pcan.2009.37

Keywords

This article is cited by

Search

Advanced search

Quick links